27/10/2011

Psychosocial interventions for people with dementia - are they specific?

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Psychosocial interventions are being studied thoroughly in the field of dementia. Some interventions are recognized for targeting cognitive functions, some others emotional processes, and so on. All of them aspire to enhance quality of life of people with dementia.

Approaches of dementia care are often based on positive psychology modalities and aim at avoiding malignant psychology processes from caregivers, as defined by Tom Kitwood.

Bringing a specific approach into this field has led carers, researchers, practitioners to rethink a way of processing for these people, thus to consider and interact with them in another way. Bringing a specific approach to an underestimated matter is a way to seek attention from pairs. The dominant model of care in our societies being the medical approach, people with dementia have unfortunately inherited of an approach considering them as ill, incapable of deciding, and sometimes debilitated… on the other hand it would not be fair to consider the medical approach with only bad outcomes knowing all that has been done toward a better knowledge of the biological background and diagnosis of people with dementia and all the efforts that are deployed in order to find a treatment.

Let’s not forget that the underlying biological processes (neuro-fibrilary tangles and senile plaques due to excess of Tau protein and Amyloid Beta in the brain) found in dementia are also found in any ageing people, only in a higher quantities – that’s what makes it pathological according to the Gaussian curve.

Living with a difference (compared to majority) is a condition that is not easy in our society and that is difficult to cope with. Let’s face it! Some people have different skin color compared the majority of people in their country, some people have different sexual orientations, some people have motor handicaps, some people cannot hear and some others cannot see, some people have cancer, some people are too fat and some others too thin. As all these differences, dementia is a matter of biological and life exposure lottery, but over all people with dementia remain Persons. For those with dementia, whatever the circumstances are, it should then be possible to express themselves solely on their condition in order to be accepted as they are and to speak for themselves instead of spoken of by a third party. Could you imagine a conference on homosexuality with heterosexual speakers talking about what they like, how they are, how they think? These speakers would probably be waited for outside the conference hall by a hoard of angry people, and it is understandable. It is common to hear such things in conferences about dementia or even visits of special care units (e.g., “Oh of course they [people with dementia] appreciate fiddling with things in cupboards and to wander around in circles!”). I have done so myself in several occasion, not with a bad meaning, but surely forgetting the matter of my research and my fight.

Meeting people with dementia in my practice and listening to them in social events and conferences about their condition has made me realize how medical, impersonal and somehow impertinent we (speakers) could seem to their eyes. We are talking about relevant matters that are taking care of and accompanying people with dementia - not treating any old fungus on the bottom of the feet. It is important that people with dementia be their own advocate as long as they can, and for us to advocate needs of people with dementia that cannot express themselves. So maybe it is time that we admit speaking merely about something we [speakers, researchers, practitioners] guess people with dementia would appreciate and admit that “specific” is sometimes maybe not.

The question that remains is the particularity of all these approaches for dementia care. Have they all been studied for the purpose of dementia or are they simple outcomes of common sense (e.g., reminiscing life events can often turn up to be emotional, activities of daily living is what we all do everyday, Sudoku & cross words call for similar processes found in cognitive therapy, planning a care unit requires knowledge about how everyone would live, …)? And to which point common sense can serve the cause of dementia? 

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